HomeMy WebLinkAbout904 20TH ST - Building Permits1
(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUI�LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 904 W 20TH ST
Suite:
Vicinity:
Parcel Number: 42249442
Zoning:
Applicant: ROGERS, MICHAEL 8� REBECCA
Address: 904 20TH ST
Phone: (949)646-5142
COSTA MESA, CA Zip: 92627
Owner: ROGERS, MICHAEL & REBECCA
Address 904 20TH ST
Phone: (949) 646-5742
COSTA MESA, CA Zip: 92627
Contractor.
Address:
Zip:
Arch :
Address:
Phone:
License:
Eng:
Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 05/032001
Issued: OS/032001
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF INSTALL 1/2" CDX . 2-i5L8 FELT AND 30 YEAR COMP. SHINGLES. -
Plan Check: $0.00
Permit: $83.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
SETBACKS '. ;
MAIN STRUCTURE �Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
FEE SUMMARY
Calc Valuation: S2,aso.00
Claim Valuation: S2,aso.00
PLANNING 8 ZONING
� Left 0- 0 - Rigfit 0- 0
Left 0- 0, Right 0- 0
Proposed: 0 � .
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRA710N: This permit shall automatically expire and become voitl if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspeetions and final approval must be obtained. Failure to obtain inspections and �inal approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
2dd6-06 (fi/00)
WORKERS' COMPENSATION DELLAAA710N:
I hereby attirtn untler penalry of perjury one of the following detlarations:
v..
❑ I heve entl wlll maintein e ceelficete of cronsent to sell-Insure for workars' compensatlon, es providatl for hy section 3700 of the Labor Cotle, for the peAormenco of the
work for which Ihis permil is issuetl.
❑ I hava antl will meintain workers' compensation insurance, es requiretl by sectlon 3700 of Iha Lebor Cotle, for the peAortnance of ihe work for which ihis pertnit Is Issued.
My workers' compensation Insurance wrrier end policy num6er ere:
Carrier. Policy Number.
(This section neetl not be comp/etetl il the permit is velued ef one hundred dollers (5100) or /essJ
❑ I certify that in the performence of iha work for which this permit is issueQ I shell not employ eny person in eny menner so as to become subject to the workers'
compensetlon lews of Calitornle, end egree Ihet H I shoul0 become subject to the workere' compensetion provislons of Section 3700 of the LaDor Code, I s�all forthwith
comply with these provislons.
Applicant Signeture: Dete:
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNUWFUL AND SHALL SU9IECT AN EMPLOVER TO CRIMINPL PENALTIES rWD CIVIL FINES UP TOONE HUNDRED
TFKKISAND DOLURE (5100,000). IN AD�RION TO THE COST OF COMPENSATION, DPMAGE$ PS PROVIDED FOq IN SECiION 3108OF TME LABOR WDE, INiEPEST, AND FTfORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirtn thet I em licensatl untler pravisions of Chapter 9(commencing with Saction 7000) of Division 3 oi the Business antl Protessions Cade, antl my Ilcense Is In full
force entl eXecl. Uc. a Class s
Contractors SlgneWre: Date:
CONSTRUCTON LENDING AGENCV:
❑ I hereby eflirm Ihat there is a construction lentling agency for the peAormance of the work br which this pertnit is issued. (Sec. 3097, Civil Code).
LendeYs Name: Lentler'S Adtlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn thet under penelry oi perjury that I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professlons
Code: Any city or county which requires e permit to construct, aller, Improve, demolish, or repeir eny structure, prior to its issuance, also requires the applicanl for such pertnit
ta file a signatl statement Ihat he ar she Is Ilcensetl pursuent to the provisions oi Ihe Contractors License Law (Chepter 9(commencing wlth Section 7000) of Dlvislon 3 of the
Business end Professlons Code) or that he or she is exempt iherefrom end ihe basis lor the ellegatl exemptlon. Any violation of Section 7031.5 by eny applicent for a pertnit
sub�ects t�e epplicant to e civil penalry oi not more than five huntlred tlollars (5500).):
❑ I, es owner ol the property, or my employees with wages as their sole compensation, WILL DO TME WORK, entl the strucWre is not intentletl or oflered for sele (Sec.
7044, Business end Professions Coda: The Coniractors License Law does not apply to en owner of property who builds or improves thereon, and who does such work
himselt or herself or through his or her own employees, provided that such improvements ere no� Intended or oMeretl for sale. If, however, the builtling or Improvement is
sold within one year of completion, the owner-builder will heve the burden of proving that he or she did not build or improve tor purpose oi sale.).
❑ I, e5 awner of Iha property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruc� �he projec� (Sec. 7044, Business and Professlons
Cotle: The comractors Licensa Law do n apply ro en owner ot propeny who bullds or Improves thereon, and who comracts tor such prolect with a contractor(s)
� license pur5uent t� Coniredors � ens Laws.).
Business antl Professions Code lor this reason:
enfi y tlrivels license. ❑ No
of nership by (rype ol docume , i.e. - property tan bill or
No.
Date:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby cenify thet no excavetion tNe (5) or more feet in depth into which e person is requireE to tlescend, will be made in connecilon wit� work euthorizetl by ihis
pertnil, and that no building sfructure, scaHolding, lelsework, or demoli�ion or dismantling Ihereof, will 6e more than t�irry-six (36) leef high. (Chap. 32, Grp 2, An 2, Sec.
347, Title 8, Celifomia Administretive Cotle).
❑ As ownerbulltler, I will not employ enyone to tlo work w�ich woultl require e permit trom Ihe Division ot Indusiriel Selety, as notetl above, unless such person hes e
partnit to da such work Irom tha division.
SignaWre: Dare:
Divisian ot Industnal Sefery Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 W ill the eppllcant or present or tuture building occupant neetl to tile entl certify e Business Plan for emargency response to release or threatened releese of a hezer0ous
meteriel7 ❑ Ve9 ❑ No
(Section 25505 oi Ihe Calitornie Health antl Safery Code requires, with some ezceptions, Ihat a Business Plan be filetl with the Coste Mesa Fire Depertment Dy every
business which has at eny one lime during a reported year a quamity ol hazartlous matenals equal to or greater than a weight of 500 pounds, or a volume o155 gallons,
or 200 cubic feel ot wmpressetl gas at standard tempereture and pressure�.
........................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the epplicent or present or future building occupan� need �o lile a regisiretion form lor ecutaly hazardous materials? ❑ Yes ❑ No
(Section 25533 ot Iha California Health and Safery Code, with some exceptlons, requires registretlon with the Coste Mesa Fire DeOartment by each �usiness which at any
one time �es an hentl a quantity of ecutely hazardous materials equel to or greeter Ihen a weight of 500 pounds, or a volume ol 55 gallons, or 200 cubic teet ol
compressetl ges et standarC temperaWre antl preuure).
...................................................................................................................................... ................................................................._._.............................................................................................................................................
3 Does or will Ihe applicam or presenl or fuWre building occupant need to prepare an RMPP (Risk Managemeni antl Prevention Program tor aately harardous matenals)?
(Section 2553d of the Califomia Health and Safery Code provides iha� Ihe Costa Mesa Fire Depariment may require ihe preparalion, certitication anA filing with the Fire
Department at an RMPP by businesses which ere required to register ecutely �ezertlous mateAals with the Fire Department.
....................... ......................................................... ........................................................................................................................................................._.........................................................._
4 If en RMPP is presently reduired, has Section 25534 of t�e Califomia Heelth and Sefery Code been fuly comDlietl with? ❑ Ves ❑ No
5 Does or wlll �he epplicant or presant or fuWre building occupant requira tor ihe work which is ihe subject of ihis a plication a permit lor such constructlon or motlification
fmm the South Coest Air Oualiry Management Disidct or tmm any othar elr pollutlon coniml tllsMct or egenc/t � Ves �J No
(Section 650502 oi ihe Calitomia Govemment Code requires iha� Ihe raquestetl inlormation be tumis�ed on ap0����ions tor nomresitlen�iel builtling parmlts).
.........................__...................._............................_...._.............................................._..........................._...........................__._...............................__.........................................................................._............................._......................""'
8 W ill any part of the faciliry m be constructed under this Dermit be within t0001eet irom �he outer 6oundaries of a school? ❑ Yes ❑ No
Qf yes", Ne tacility must meet the requirement of Sections 25534 antl 42303 0l ihe Calitomia Heallh and Safery Code).
..........................................................................................._............................................................................................................................................................................................................................._............................................................
7 N a permil irom Ihe South Coast Air Ouality Manegement District or olher elr pollutlon control district or egency is required for the work which is ihe subject ot this
epplication, have ell ot the disclosures prescribed by Celilornia Health end Sufety Code Section 42303 been mede? ❑ Yes ❑ No
........................................................................................................................................................................................................................................................................................................................................................................................
B QI "yes", etlec� certificate of compliance fmm ihe appropriate air pollution control otticer).
CERTIFICATE OF COMPLIANCE: I cenity that untler penalty of perjury Ihe intormation given ebove is correcl I agree to comply wiN all state laws and ciry ortlinances
regarding Hezertlous Matenals and Emissions.
SlgnaWra: Date:
CERTFICA7E OF COMP hNCE AND ORI ON,6F ENfHY: I cetlity under penalty of porjury ihat I have read this epplication and state Nat �he informetion given is
correct I agree to with all�t e la� s a ciry Ibmances relating to bulltling constmction, and authorize representatives of Ihe City of Costa Mesa to enter upon the
ebove-describ � y f^r ins �ction p ryo s. I�ee not to occupy or ellow occupency of any building au�horized by this permi anC final inspection.
, -O/-
Si ture Of L aFBw q' Date
Antl/Or oolicant e
GODE �. INSFECTONTYPE
1616 Fi:etl System Final Fire Prevention
7266 Paol Spe Final
200 Finel Re-Roof
201 Flnal BIocWRe�aining Well
202 Final Fectory Fira Place
203 Final Sign
204 Final Demolition
p�j� �$ j�Qpf,� INSpELTIONTYPE
206 Final Mechanical
200 Final Plumbing
10 /� �/7N�1�'� 210 Final Elecinwl
Q 212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Finel Building/Occupancy
O�TE IMRI�lS
-
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 904 W 20TH ST
Suite:
Vicinity: ADDITION @ REAR AND SIDE OF HOUSE
Parcel Number: 42249442 Zoning:
Applicant: ROGERS, MICHAEL
Address: 904 20TH ST
COSTA MESA, CA
Phone: (949) 646-5742
Zip: 92627
owner: ROGERS, MICHAEL & REBECCA
Address 904 20TH ST
COSTA MESA, CA
Contrector: OWN ER-B U I LDE R
Address:
Phone: (949)646-5142
Zip: 92627
Phone:
ISSUED BY:
Status: ISSUED
Applied: 03/01/2001
Issued: 04/11/2001
Zip: 1 License: 0 � '
Arch : JUREACK, RUDY Eng:
Address: 2062 BUSINESS CENTER DR Address:
SUITE 240 Phone: (949) 833-9330 Phone:
IRVINE, CA .
Zip: 92612 License: License:
SCOPE OF PERMIT
ON 4111/01- REVISED PLANS SUBMITTED TO DELETE 391 SF MASTER BEDROOM AND BATHROOM; PLUS GAR4GE
REDUCED TO 514 SF. 20 Ff FRONT SETBACK MAINTAINED AND SIDE SETBACK FOR GARAGE IS 6'4". 20' BY 20'
CLEAR DIMENSIONS MET FOR GARAGE.
CONSTRUCT391 SQ FT MASTER BEDROOM & BATHROOM ADDITION 8 NEW 552 SQ FT 2-CAR ATTACHED GARAGE, 87SQ
FT COVERED ENTRY PATIO. MISC ALT INSIDE HOUSE.
Plan Check: $172.41
Permit: $265.25
SMIP Res: $1.59
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: ' $439.25
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
CalcValuation: Sis,9aa.sa
Claim Valuation: � , $o.00
PLANNING & ZONING
Left 0. 0 Right
Left 0. 0 Right
Pr000sed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regula[ions. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This pertnit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned
for a period ot 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons and flnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expirationof this permit. :. /
FOR INSPECTIONS CALL: (714) 7545626 � �
2Cd&d6 (NW)
WORKERS'COMPENSAnON DECLARAnON:
I hereby aMirm under penalty ot perjury one oi the following declarations:
❑ I have antl will meintain e canificate of consent to self-Insure for workers' compensatlon, es pmvltled for hy section 3700 of t�e Lebor Cotla, for Ihe pertormence of the
wark 1or which IhiS Oermit is issuetl,
❑ I have entl will maintain workers' compensation Insurance, as requiretl by section 3700 0l Ihe Labor Coae, for the peRoimance ol Ihe work tor which ihis pertnit is Issued.
My workers' compansali0n Insurance csrner antl policy numbar ere:
Cerrior: Policy Number:
(This section need nat be cromplefed i/ the permit is valued at one hundred dollaro ($ 700) ar less.)
❑ I certity lhet in Ihe pertormence of ihe work for which this permit i5 issued, I shell noI employ any porson in eny manner so es to become sublect ta the workers'
compensetlon laws ol Celifornia, antl egree that if I should become subject to the workers' compensation provislons ot Section 3700 0l the Labor Code, I shall forthwith
comply with these provislons.
Appliwnt Sipneture: Date:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJEC� AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
TIqU,SPND DIX.URE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIOE� FOq IN SECTIIXJ 3]OB Oi THE IABOR CODE, IMEREST, AND ATfOf1NEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I here6y aHirm that I em licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 0l ihe Business antl Professions Code, antl my license is in full
� torce entl eMect. Lic. q Cless N
Comractafs Signeture: Date:
CONSTRUCTION LENOING AGENCY:
❑ I hareby aHirtn that thera is a construction lending agency lor ihe peAormance ot lhe work for which ihis permit is issued. (Sec. 3097. Civil Code).
Lenders Name: Lender's Address: � �
Signature: Date:
OWNER•BUILDER DECLARAT10N5:
I hereby ettirm ihat untler penal�y of perjury thet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Professlons
Code: Any ciry or county which requires a permit ro constmct, alter, improve, demolish, or repair any siructure, prior to its issuance, elso requlres lhe applicant tor such permit
to tlle e signeA statemant ihat he or she is licensed pursuant to lhe provisions ol tha Contractors License Lew (Chapter 9(cammencing with Section 7000) of Division 3 of the
Business and Professions Code) or that �e or she is exempt therefrom and the basis for the allagetl exemption. Any violation oi Sectlon 7031.5 by eny applicant tor a pertnit
sublecis the applicant to e civil penalry of not more then tive hundred dollers ($500).):
❑ I, es owner of Ihe O�operty, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, end Ihe siructure Is not imentled or ottered for sale (Sec.
7044, Business antl Professions Code: The Contractors License Law does not apply to an owner ol pwperty who builtls or impmves thereon, and who does such work
hims or hereelt or thmu9h his or her own employees, pwvided ihat such impwvements are not In�ended or oflered lor sale. If, however, Ihe builtling or improvement is
s within one year ot completion, th w r-builtler will have the burden ol proving ihat ha or she tlitl not build or improve for purpose ol5aie.).
� es ownerl�f t��operty, em EXC USIV LV CONTRACTWG WITH LICENSED CONTRACTORS to constmct the project (SecJOd4, Busine55 and Prolession5
� Code: T on t rs License does t apply to an owner of pmperty who builds or Improves thereon, and who coniracts tor such project wlih a contrector(s)
licens ur5ua t the Con�rec r Licen e Lews.).
��I Bm f
Signature: --
Owner ID ven
Verifiwtlon of
sec.
by (type ol
Business and Professions Cotle for this reeson:
�No �Drivers License No.
property tax 6ill or tleatl):---"" "��
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlity ihat no excavation five (5) or more feet in depih irno which a person is required to descend, will be matle in wnnection with work auihonzed by this
pertnit, end Ihat no building siructure, scaflolding, falsework, or demolition or dismantiing t�ereol, will be more lhen lhirty-siz (36) feet hiph. (Chap. 3.2, Grp 2, Ar12, Sec.
345, 71t1e B, Califarnia Atlministrative Code).
❑ As awner-builtler, I will not employ anyone to tlo work which woultl require a permit imm the Division of Industrial Salery, es noted above, unlass such parsan has a
permit to tlo such work irom I�a tlivision.
SignaWre: Date:
Division of Industrial Salery Permit Number:
CO�E �. INSPECTIONTYVE
1616 Fixed System Final Fire Prevemion
1266
200
201
202
203
Pool SOa Finel
Finel Re-ROoi
Final BIocWRetalning Well
Final Fectory Fire Place
Final Sign
204 Finel Demolition
o"re� INRriALS
CO�E I INSPECTION TYVE
206 Final Machanical
208 Final Plumbing
210 Final Elecidcal
212 Flnal Fire Prevention
220 Final Planning ADProval
2AIE 1I�AL9
222 Final Site
250 FinalBuiltling/Occupanq 10-II-�� (�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 9�4 W ZOTH $T
Suite No
Vicinity: NEW GARAGE
Parcel Number: 42249442
npplicant: ROGERS, MICHAEL
Address: 904 20TH ST
COSTA MESA, CA
MECHANICAL PERMIT
Phone: (949)646-5142
Zip: 92627
Owner: ROGERS, MICHAEL & REBECCA
Address: 904 20TH ST
Contractor.
Address:
COSTA MESA, CA
OWNER-BUILDER
Phone: (949)646-5142
Zip: 92627
Phone:
Zip:
License: 0
ISSUED BY:
Status: ISSUED
Applied: 04/i t/2001
Issued: 04/11/2001
SCOPE OF PERMIT
MECHANICAL PERMIT FOR NEW 2-CAR ATTACHED GARAGE. INSTALL 1- 100K BTU FAU & GAS
PIPING.
REF: B01-00271
ISSUE FEE
Inst FAU <100 k BTU ,
Inst FAU >100 k BTU
Repair/Alt Cooling/Heat
Inst / Rep. Recess Wall Htr
Refrig Sys <700 k BTU
Refrig Sys >700 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct'
Appliance
Fire Dampers �
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < 70000cfm
AirHandlers> 10000cfm
FloorFurnace
Floor or Suspend Heater
$23.50
$14.80
$0.00
$0.00
$0.00
$0.00
$0.00
$6.15
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
FEE SUMMARY
Repair / AIt Absorbtion Unit
Repair / Alt Refrigeration Unit
Ventillation System
Evaporetive Cooler
Commercial I ncinerator
Domestic Incinerator
Compressors / Absorption Systems
Up to 3 hp / 100 k�BTU
3 To 15 hp / SOOk BTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 7,750 k BTU " �
Over 50 hp I Over 1,750 BTU �
Boilers � � ,
Up to 3 hp
3To15hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0 �
$0.00 0
$0.00 _ 0
$0.00 0 �
$0.00 0
�$0.00 0 �
$0.00. 0
$0.00' !0
$0.00�' 0
$0.00 0
� $0.00 0
$0.00 0
$0.00 0
$0.00 0
S0.00 0
$0.00 0
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES E44.45
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned !
for a period of 180 days. �
i'
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectlons and (inal epproval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration. of this permit/
FOR INSPECTIONS CALL: (714) 7545626 %
2Cbfi�4fi(fi�00)
WORKERS' COMPENSATION DECLARATION: �
I hereby aHirm untler penalry ot perjury one of the tollowing declaretions: �
❑ I heve antl will maintain a certificate of consent to self-Insure for workers' compensatlon, es provided tor by section 3700 of ihe Lebor Code, for ihe peAormance of the
work for which this permit is issued.
❑ I have antl will mak�iain wodcers' compensation insurance, as required by section 3700 of Ihe Labor Code, for the pedortnance of the work for which ihis pertnit is issued.
My workers' compensa�lon Insurance carrier antl policy number are:
Carrier: '-r Policy Number.
(This secfion need not be crompleted il the pemrit is velued ef one huntlretl tlollars ($100) or Iess.J
❑ I certify thet in the pertortnance of the work for which ihis pertnit is issued, I shall not employ any person in eny manner so es to become subject to ihe workers'
compensation laws of Califomia, and agrea that ii I should 6ecome su6ject to Ihe workers' compensetion provisions of Section 3700 of the Labor Coda, I shall torthwith
comply with these provisions.
Applicant Signature: Date:
WARNING: FAILURE TO SEWRE WORKERS' COMPENSATIqJ COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAN� DOLLARE (5100,Opp), IN ADDITION TO THE COST OF COfAPENSATION, DAMAGES AS PROVIDED FOq W SECTION 3]Ofi OF THE LABOR CADE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Pmfessions Cotle, and my license is in full
force antl eHect. Lic. q Class a
Contraaols Signature: Date:
LENDING AGENCV: �
❑ I hereby aflirtn ihat there is a construction lentling agency for the peAormance of ihe work for w�ich �his permit is issued. (Sec. 3097, Civil Cotle).
LenGer's Name:
Signature: _
OWNER•BUILDER DECLARATIONS:
Lentler's Adtlress:
Data:
I hereby aflirtn that under penalry of perjury ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business entl Professions
Cotle: Any city or county which requires e pertnit to consiruct, alter, improve, tlemolish, or repair eny stmcWre, prior to its issuance, also requires the epplicant for such permit
ro file a signetl statement that he or she is licensed pursuant to the provisions oi the Contractors License Lew (Chapter 9(commencing with Sectlon 7000) oi Division 3 of the
Business end Pmfessions Code) or thet ha or she is exempt therefrom and ihe besis for the ellegatl ezemption. Any violetion of Section 7031.5 by any applicent for a permit
sublects ihe epplicent 10 e civil penalry of not more ihan five hundred dollars ($500J.):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, end ihe sWc�ure Is not intentle0 or ottered for sale (Sec.
7044, Business and Professions Code: The Contrectors License Law does not apply to an owner oi propetly who builds or improves thereon, and who does such work
himself or herseN or ihrough his or her own loyees, providetl that such improvemenis ere not imentled or ottered for snle. If, howaver, the builtling or improvement is
��/'�sold within one year of completion, the ow r- tlder will have the burden of proving Ihat he or she ditl not �uild or improve for purpose of sale.).
,IY7! I,.as owner of the Oroperty, em E%CLU VE CONTRACTING WITH LICENSED CON7RACTORS to constmct the project (Sec. 7044, Business antl Professions
Code: The contractors License �d es n appty to an owner oi propetly who builtls or Impmves Ihereon, antl who contracts br such project with a contracror(s)
license oursuaol tolhe Conir tork cens Laws.1.
❑ lam
Business and Professions Code for this reason:
Owne� ID veri4ie�iiy tl{IveYs licensa `[�'es U❑ No 1 Driver's License�Nor'.
Vedfication of Ownership by (type of tlocumen�, i.e. - property tax bill or daed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation tive (5) or more feet in tlepth in�o which e person is required to descentl, will be mede in connec�ion with work authorizetl by ihis
permit, end thet no building simcture, scaHolding, falsework, or demolition or tlismantling thereof, will be more than thlny-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
34 i, Title 8, Calitornia Administrative Cotle).
❑ As owner-builder, I will no� employ anyone to do work which would require e permit from ihe Division of Intlustrial Sefety, as noted above, unless such person hes a
permitto do such wark fram ihe division.
Signature: Date:
Division oi Intlusirial Safery Pertnit Number:
COOE 1, MSPEGTIONTYVE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Finel Sign
20G Final Demolition
OpTE' INTITIFL
�
CODE I INSPECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
Qsj$ N R Rl
lo-Il-ol N
��
(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 904 W 20TH ST
Suite No
Vicinity: NEW GARAGE
Parcel Nunmber: 42249442
Applicant: ROGERS, MICHAEL
Address: 904 20TH ST
COSTA MESA, CA
PLUMBING PERMIT
Phone: (949) 64&5142
Zip: 92627
Owner: ROGERS, MICHAEL 8 REBECCA
Address 90420THST
Contractor.
Address:
Arch / Eng :
Address:
COSTA MESA, CA
OWNER-BUILDER
Phone: (949)646-5142
Zip: 92627
Phone:
Zip:
License: 0
Phone:
Zip:
License:
ISSUED BY:
Status: ISSUED
Applied: 04/i V2001
Issued: O4171/2001
SCOPE OF PERMIT
PLUMBING PERMIT FOR NEW 2-CAR ATTACHED GARAGE. INSTALL 3 GAS OUTLETS, 7 WASHER, 1
SEWER CONNECTION, 1 WATER HEATER, 8 WATER PIPING.
REF:807-00271
AMT
ISSUE FEE , , $23:50
Backflow irrigation $0.00
Backflow Preventer $0.00
Bathiub $0.00
Clarifier System $0.00
Connect (Ice,Soda,etc) $0.00
Dental Units $0.00
Dishwasher $0.00
Drain, Floor $0.00
Drain, Rainwater $0.00
Drain, Roof $0.00
Drinking Fountain $0.00
Expansion Tank $0.00
Gas Earthquake Valve $0.00
Gas (1-4 outlets) $6.15
Gas (Over 4 outlets) $0.00
Gas Repipe $0.00
Gas Service $0.00
Interceptors (Grease, Oip $0.00
Interceptors (Sand Auto ) $0.00
QTY
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
FEE SUMMARY
AMT
Laundry Tub I Washer $9.80
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap (or Demo $0.00
Sewer Connecl $24.65
Sewer Private Line $0.00
Shower $0.00
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
Qrv
7
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
SumpPump
Swimming Pool � -
Trap Pnmer �
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater I vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Sokener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
50.00
$0.00
$0.00
50.00
$0.00
50.00
50.00
50.00
$0.00
$0.00
312.30
$9.80
50.00
50.00
$0.00
$0.00
50.00
$0.00
$0.00
TOTAL CALCULATED FEES: E86.20
/
QTY
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
NOTICE: The work authorized by this permit s�(y���ji$ pg�� ��jamp� requirements under Calilornia statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandonetl
for a penod of 780 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and'all
requlred Inapections and final approval must be obtained. Failure to obtain inspections and final approval will resWt in the expiratiortof ihis permi�
FOR INSPECTIONS CAIL: (714) 7545626 %
2446�48(fl�00)
WORKERS'COMPENSAnON DECLARAnON: .
I hereby attirtn under penalry of pe�ury one ot the following tleclarations:
❑ I have entl will malntain a cetlificate of consent to setl-Insure tor workers' compensation, es provided for by section 3700 oi the Labor Cotle, for the pertortnence oi ihe
work tor which�, his pertnil is issued.
❑ 1 have antl will maintain workers' compensation insurance, as required by section 3700 ol Ne Labor Code, for ihe peAortnance ot the work for whicti this pertnit I5 Issuetl.
My workers' com�rf5alion Insurance carner and policy num0er are:
Cartier. PoliCy Number.
(This sectlon need not be comp/e7ed iI fhe permit is velued ef one hundred dollars ($100) or /ess.)
❑ I certify ihal in the peAortnance oi the work tor which ihis pertnit is icsued, 1 shall not employ any person in any manner so as to become subject to the workers'
compensetion laws of Calilornie, antl agree Ihat If I should bacome sub�ect to Ihe workers' compensalion provisions ol Section 3700 of Ihe Labor CoOe, I 5hall forthwith
comply with these provisions.
Applican� Signeture: Date:
WARNING FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHALL SUBJECi AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRE�
THOUSAND DOLURE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOii IN SEGTION 3106 OF THE UBOR COOE, INTEREST, AND AiTORNEI"5 FEES.
LICENSED CONTAACTORS DECLARATION: '�
I hereby aHirtn that I am licensad under provisions of Chapter 9(commencing wiih Section 7000) of Division 3 ot the Business anA Professions Coda, and my license is in tull
tome and eNecL Lia M Class #
CoNractoYs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby aNirtn that there is a construction lending agency tor the pertortnance ol ihe work for w�ich Ihis permit is issuetl. (Sec. 3097, Civil Cotle).
Lentlers Name:
SignaWre: _
OWNER-BUILDER DECLAHATIONS:
LentleYs AtlAress:
Date:
I hereby aHirtn that under penalry of perjury that I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Protessions
Code: My ciry or county which requires a pertnit to wnstruct, alter, improve, demolish, or repair any strucWre, pnor to its issuance, also requires ihe applicant for such pertnil
to tile a signed statement that he or she is Ilcensed pursuant to Ihe pmvisions of Ihe Coniractors License Law (Ghepter 9(commencing with Section 7000) ot DiNslon 3 ot Iha
Businew antl Professions Code) or that he or she is exempt therefrom entl tha �asis for the elleged ezemption. Any violation of Section 7031.5 by eny epplicant for e permit
� istthe appliwnt to a civil penalry of not mora than tive �undred dollers (5500)J:
,I, as owner of the property, or my employees with wages es t�eir sole compensation, WILL DO THE WORK, and the sWcture Is not intendad or otterea for sale (Sec.
044, Business antl Professions Code: The Contractors License Lew tices not apply to an owner of property who builds or improves thereon, and who tloes such work
himself or herself or through his or her own employees, provided that such improvements ere not imended or oHerea for sale. If, however, the building or improvemem is
soltl within one year of completion, the ownerbuilder will hava the burden of proving that he or she did nol builtl or improve for purpose ot sale.).
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTiNG WITH LICENSED CONTRACTORS to consiruct the prolect (Sec. 704d, Business antl Professions
Code: The conirectors License does not appty to an owner of pmperty who builds or improves thereon, end who contrects br such pmject with a contractor(s)
license pursuant to lhe Con or License LawsJ.
❑ I am e:em er sea eusiness end Professions Code for this reason: ._
SignaNre: ��qu .�r-7���� �Date�
Owner ID n b�tlnvers I¢ense. �Yes � No ,�--Dmers LicenSe No. _� � � r�.Expires:_ %DOj .
Venlication of Ownership by (type ol document, i.e. - properry tac bill or deed): __
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify thet no excevation tive (5) or more feet in tlepth imo which a person is required to descend, will he made in connection with work aNhorized by ihis
pertnit, and ihat no building structure, scaHolding, talsework, or demolition or dismantling thereof, will be more ihan Ihirry-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
345, Title 8, Calitomia Adminis�rative Code).
❑ As owner-builder, I wiil not emDloy enyone to do work which would require e permit from the Division ol Industnal Safery, as notetl ebova, unless such person hes e
pertnit ta do such wark twm the division.
SignaNre: Date:
Division ot IndusMal Satery Pertnit Number.
GODE �. INSGECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roaf
201 Final BIocWRetaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Damolition
Qy1�' RL
COpE• INSPECTIONTYVE
20fi Final Mechanical
20B Finel Plumbing
210 Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222
250
Final Site
Final Building/Occupency
P�7E I[+�4$
Y � � l
�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Appliwnt:
Address:
904 W 20TH ST
NEW GAR4GE
42249442
ROGERS, MICHAEL
904 20TH ST
COSTA MESA, CA
ISSUED BY:
Phone: (949)646-5142
Zip: 92627
owner: ROGERS. MICHAEL 8 REBECCA
Address 904 20TH ST
COSTA MESA, CA
Contrector: OWN ER-BU I LD ER
Address:
ISSUE FEE
�Temp service test
Res. a/c pacliage
New Res (1-2 units)
New Res (3+units)
Pool / Spa �
Lighting Fixts� .
Recept Outlets � � �,
Switchea
Non Res Appl �
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
Phone: (949) 64G5142
Zip: 92627
Phone:
Zip:
License: 0
Status: ISSUED
Applied: 04/11/2001
Issued: 04/17/2007
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR NEW 2-CAR ATTACHED GARAGE. INSTALL 19 LIGHT FIXTURES, 11
RECEPTACLE OUTLETS, 12 SWITCHES, 8 200 AMP ELECTRiCAL SERVICE.
REF:BOi-00271
$23.50
so.00
$0.00
50.00
$0.00
$0.00
$20.90
, $12.10
$1320
$0.00
$0.00
$30.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
19
11
12
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /700 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up l0 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment -
Low Volt Wiring System / Ckt
Misc. Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspeclion Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0 '
$0.00 0
$0.00 0
$0.00 0 /
$0.00 0 �
$0.00 0 '
50.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
50.00
$0.00
TOTAL CALCULATED FEES E100.20
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by ihis permit shall comply witn all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
tor a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inepeetiona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit.
FOR INSPECTIONS CALL: (714) 7545626 �
zaaews �sroo�
WORKERS'COMPENSAnON DEC�AnON:
I hereby atfirtn untler penalry of perjury one oi Ihe following declaretlons:
❑ I �eve end will meintain e certi�icate ot consent ro self-Insure lor workers' compensatlan, es provitled for by section 3700 of ihe Labor Cotle, tor the pertortnance of ihe
work lar which thi5 pertnii is issuetl.
❑ I have entl will meintain workers' compensation insurance, as requiretl by sectlon 3700 of Ihe Lebor Code, for the pedortnance ot the work for which this pertnit is issued.
My workers' compansellon Insurence carrier and policy number are:
Cerrior: Policy Number:
(This secNon neetl not be completeA�� (he permit is velued et ane huntlred tlollers ($100) or less.)
❑ I certify Ihet in ihe peAormenca o� Ihe work for which Ihis permit is i�sued, I shall no� employ eny person in any manner so as lo become subject to ihe workere'
compensetlon laws of Californla, antl agrea that it I shoula become sub�ect to the workers' compensation provisions ot Sectlon 3700 of the Lebor Cotle, I shall forthwith
comply with ihese Orovislons.
Applicant SignaWre: Date:
WARNINO: FAI W RE TO SECURE WORNERS' COMPENSATIOfJ COVEMGE IS UNIAWFUI rWD SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIViI FlNES UP TO ONE HUNDRED
THOUSAND DOLURE (510p,00p). IN ADDITIIXJ TO THE CQST OF COMPENSATION, DAMAGES A$ PROVIDED FOR IN SEGTIOtJ 3]O60F iHE IABOR CODE, INTEREST, AND ATTORNEVS FEES.
LICENSED CONTRAC70R5 DECLARATION:
I hereby ettirm that I am licansetl untler pmNsions of Chapter 9(commencing with Section 7000) oi Division 3 of ihe Business antl Protessions Code, entl my license is in full
force entl eMact. Lic. N Class k
Comrectofs Signeture: Da�e:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm that t�ere is e construcuon lending agency for the pedortnance ol tha work for which this permit is issued. (Sec. 3097, Civil Code).
Lentler's Name:
Signeture: _
OWNER-BUILDER DECLARATIONS:
Lender's Atltlress:
Dete:
I hereby aHirm thei untler penalry ot perjury Ihat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city ar couniy which requires a permit to consiruct, alter, Improve, demolish, or repeir eny structure, pnor to its Issuance, also requires ihe applicant for such permit
b tile e slgned statement thet he or she is licensed pursuant to Ihe provisions oi I�e Contractors License Law (ChaD�er 9(commencing with Sactlon 7000) ol Division 3 oi the
Business entl Protession5 Code) or Ihel he or she is exempt therefrom end ihe basis lor Ihe ellegad exemption. Any vloletlon ol Section 7031.5 by eny epplicant lor a pertnil
subjects the epplicant to e civil penel�y oi no� more than tive hundred dollars (5500).):
❑ I, es owner of the property, or my employees with wages as their sole compensetion, WILL DO 7HE WORK, and ihe sWCNre Is not imentled or oHaretl for sale (Sec.
7044, Business antl Pmtessions Cotle: The Coniractors License Lew tloes not apply lo an owner of pmperty who builtls or Impwves thereon, and who does such work
�imseN or herself or thmugh his or her own employees, pravidetl thet such improvemenis ere not intended or oflered for sale. If, however, the building or improvement is
sold within one year of comple�ion, the owner-builder will heve ihe burden of proving that he or she ditl not build or improve for purpose of sale.�.
� I; es Owner ot iha property, am E%CLUSNELV CONTRACTING WITH UCENSED CONTRACTORS fo construct the project (Sec. 7044, Business and Professions
�_Catle: The contrectors License Law does not apply to en owner of property who builds or improves thereon, and who contracts for such projeci with a conirador(s)
license pursuanl to the ComreC�ors License Laws.).
'� I am exempt under sec. Business entl Professions Code for Ihis reason: �
�—'__ � .. . .
Owner ID venlied by driver's license. ❑ Ves ❑ No r Drivefs License No. � � _ Expires:
Vedlicetion oi Ownership by (type al tlocumeni, i.e. - pmperry tex blll or deed) � �
DIVISION OF INDUSTRIAL SAFET' PERMIT CERTIFICA710N:
❑ I hereby certity Ihet no ezcavetion five (5) or more feet in tlap�h into which e person is requiretl �o descend, will be metle in connection wi�h work authorizetl by ihis
permit, antl ihat no building stmclure, scaHolding, talsework, or demolition or dismantling thereot, will be more ihan thiny-siz (36) feet high. (Chep. 3.2, Gry 2, Art 2, Sec.
34 i, Tltla 8, Celifornla Adminis�retive Cotle).
❑ As owneo-builder, I will not emp�oy anyone to tlo work whic� would require e permit fmm Ihe Division of Indusiriel Sefety, as noted ebove, unless such person has a
permit ta do such work Irom the division.
Signature: Dele:
Division ol Indusirial Sa�ery Permit Numher:
COpE I. INSVECTIONTYPE
1616 Fixad System Final Fire Pre�en�ion
1268 Pool Spa Finel
200 Finel Re-Roof
201 Flnal BIacWRetaining Well
202 Final Factory Fira Place
203
204
Finel Sign
Final Demolition
'-��
0
IMIf1AL5
COOE 1 INSPECTION ttPE
206 Final Mechanical
208 Final Plumbing
210 Final Electncel
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
Q9j� IMRIRL
, /i� ,: '�''I
�
OWNER JOHNSTON, Kenneth Da'rE 10-29-58
JOB ADDRESS $0� 41. 20th St. BUILDING PERMIT NO. %910 �
1GENERAL CONTRACTOR OW7182' VAL[IE E
. o. LOT 2I;0 TRACT 17I2 �E ZONE DESCRIPT[ON OF WORK COv. PatiO & BioCk :'eriCe
GROUP J TYPE V ZONE R-1 PLAN NO.
I ECTIONS _ I OATE I I PEHMIr5155Vto
SUBCONTRACTOR DATE
� NUMBER
7'rcnchu Porms 3tce1 �'.�/�r�j�� ��
7910
� '79�t)
�,
� COSTA MESA BUILDING. DEPARTMENT
P.O. BOX 31�
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
ADDRE'S5 �O� \A�FCI GrO�
COSTA MESA. CALIFORNIA
MAIL
A�DRE55 I
QTY O ST
ARCHITECT
OR ENGINEER
ADDRE55
LEGRL
DESCRIPTION
A.P. NO.
� t+wIST��
TM
TEL.
�o. L�
LIC.
NO.
QTY LIC.
NO.
ti IHo.or e�ocs. i
NOW ON LOT
VSE OF •—T�
exisriNc e�oc._ �V�JEL.IIAS C;
SETBPCI( LINE FROM � c�'
CErvTER OF STPEEi REAR YARD L]�
SIDE YARo RIGHT �• LEFT I�f
y
DESCRIPTION OF WORK
NEW _ x ALTERATION I AODITION
P�31R I �MOVING I �DEMOLISH
3
��ILDING� NO.OF
E X FOOMS ��STORIES
.XTERIOR WALL ROOF 1�
:;OVERING �y COVERING �O /V�QI�
USEOFNEW /,__,,...�_.,� ��,�, �{.
��� ����0���
flN/RGNC�90E����y
� � �Q �T
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
PECEIGT NO. PER/MIT NO
` O
CEIV D Y DPTE FECEIVED pwTE ISSVE
� - � �i - �
BU I LfJI NG
ADDRE55
COSTA MESA. CALIFORNIA
FIRE
ZONE
20NE pO.Ns TVPE Gqpyp,
V
BVPROVE � �ti[ DATE /O Z9 �
CORRECTIONS
��� ���r/.�{��1� �/�— � ��
I� _ L i c—n r/ �—
ECT TO BLDG.
•' c�t r o G.o b o
�_,�
- c-rr c
I HEREBY 4CKNOWLEDGE TNPT 1 NAVE REl�O THIS I�PPLICI�TION RNO
STATE THAT TME ABOVE IS CORRECT aNO AGREE TO COMPLV WITM qLL
CITV OROINGNCE$ ANO ST/TE L<WS PEGVLiTING BVILUING CONSTRUC-
non. VALUATION
SIGNATURE OF A�y' PERMIT FEE S
PERMITTEE ' `�'� /�
�� � aT/ PLAN CHECK 5
w 5
AUTHORIZEO AGENT y`�� TOTAL FEE S
rl0 `
VpMf